One. About hospital admission
On November 13, 2017, the patient Tang Moumou was admitted to the X University Affiliated X Hospital x Branch for treatment due to poor stool for more than 20 days, and was admitted to the hospital for diagnosis: constipation, hiccups to be investigated, cerebral infarction sequelae, admission examination: clear consciousness, mental energy, stable breathing, moderate nutrition, free expression, normal development, pushed into the ward, answered the questions, and examined the body. After admission to the hospital, he received relevant medical examinations and combined with medication, and his condition did not improve significantly.
From November 16, 2017, the defendant used chlorpromazine hydrochloride body injection for treatment, the first dose was 50mg, after the injection, the patient had symptoms such as lethargy, urinary and urinary incontinence, and the family clearly informed the attending doctor to terminate the follow-up injection after seeing the situation. On November 17, 2017, the defendant did not listen to the opinions of the family, nor did he explain or inform the family of the relevant situation, and continued to inject a second injection of chlorpromazine hydrochloride, and the patient's sleepiness worsened after the injection.
In the case that the family clearly informed the attending doctor that the third injection absolutely could not be injected, the defendant continued to inject the third injection of chlorpromazine hydrochloride, resulting in the patient developing from lethargy to coma, bedridden, urinary and urinary incontinence, etc., using oxygen, restraint belts and receiving physical cooling several times, completely losing self-consciousness. The plaintiff immediately negotiated with the attending doctor, the plaintiff said that "the injection must be based on the principle of favorable treatment, if it is unfavorable to the treatment to accelerate the disease must be terminated", and the doctor An Min said that "the doctor prescribes a three-day course of treatment, and the conventional medicine must be used up".
Two. About biting the thermometer
On the evening of November 19, 2017, the nurse on duty handed the mercury thermometer to the nurse without the patient's complete autonomy, using restraint bands, and did not remove the dentures in the mouth, and the nurse directly put it into the patient's mouth to measure the body temperature, resulting in the mercury thermometer breaking in the mouth and the mercury bubble with sharp edges being swallowed into the abdomen.
After discovering the above situation, the plaintiff requested an immediate examination, and the plain abdominal film showed that there was a foreign body in the abdomen, but after that, the defendant did not take follow-up treatment measures in time, but just blindly observed and told the family to wait for the next day to do gastroscopy. Under the circumstance that the family members had serious doubts about the defendant's medical ability, they had no choice but to call the 120 emergency number on their own and had no choice but to transfer to the First People's Hospital of X City.
The discharge summary issued by the defendant stated: Songjiang emergency department, lack of consciousness, non-cooperation in communication, non-cooperation in physical examination, and bloody fluid flowing out of the anus. According to this, the family reasonably deduced that the sharp edge of the vacuole had pierced the gastrointestinal tract of the patient, the situation in the abdominal cavity was self-evident and unimaginable, and the mercury in the vacuole had caused irreversible and huge damage to the patient's body.
In the First People's Hospital of X City, after several CT and enhancement, the use of gastroscopic tubes in the patient's mouth, esophagus, stomach several times, under the relay of many medical staff, at 5 p.m. on November 20, the patient's abdominal vacuole was finally successfully removed, at this time it was nearly 24 hours since it was swallowed. The damage to the patient's mouth, esophagus, stomach and other organs is immeasurable, and the health status is further deteriorated. The patient felt that there were not many days to come, and chose to continue treatment at the Zhujiajiao Town People's Hospital in X City X District, which was closer to home, and finally died on December 30, 2017 due to mercury poisoning and lung infection.
Three. The patient's point of view
Guaranteeing the patient's right to informed consent is not only a personal right enjoyed by the patient in accordance with the law, but also an obligation of medical staff. Chlorpromazine hydrochloride is an antipsychotic drug, mainly used for the treatment of schizophrenia, mania, strong sedative effect, obvious side effects, cardiovascular and hepatotoxic, the elderly should be used with caution. The patient is 83 years old, suffering from cerebral infarction sequelae, and since hospitalization, he has only ingested a trace amount of porridge for three meals a day, and his physical fitness has been very poor, and chlorpromazine injection should be cautious.
However, the defendant did not inform the family of the injection behavior, the second did not obtain the written consent of the family, the third did not inform the relevant risks, and did not consider the patient's sensitivity and tolerance to the drug, the three injections directly caused the patient to change from lethargy to coma, bedridden, urinary incontinence, etc., using oxygen, restraint belts and receiving physical cooling several times, completely losing autonomy. The defendant violates the patient's right to informed consent and shall bear the liability for compensation.
When the defendant measured the patient's body temperature, in the face of the patient who had completely lost consciousness of autonomy and used the restraint belt, he still put the mercury thermometer in his mouth, which directly caused the mercury thermometer to break in his mouth, and the patient's right to life and health was irreversibly seriously damaged. According to the regulations, the temperature measurement is the responsibility of the nurse, but it is carried out by the nurse, and the defendant has the responsibility to manage it. Therefore, the plaintiff told the court.
Four. Medical opinion
Disagreeing with the plaintiff's claim, the defendant's medical fault was mainly due to the thermometer being swallowed by the patient, and the defendant was willing to compensate the cost of diagnosis and treatment and loss caused by the thermometer swallowing according to the conclusion of the appraisal.
Five. Appraisal Opinion
X Hospital x Branch Hospital has a medical fault of improperly choosing the method of body temperature measurement and irregular operation in medical activities, and there is a causal relationship with the patient's bite and swallowing of the thermometer and the need for gastroscopy removal. With reference to the "Medical Malpractice Grading Standards (Trial)", the level of personal medical damage of a patient's gastroscopic foreign body corresponds to a grade IV medical malpractice and does not constitute disability. The degree of liability of the medical party for this medical damage is full liability.
Six. Medical fault analysis
On November 13, 2017, the patient was admitted to the hospital for more than 20 days due to repeated hiccups with stool, examination of abdominal weakness, mid-upper and middle quadrant tenderness (+), no rebound pain and muscle tension, 1-2 bowel sounds/ min, gastroscopy showed chronic superficial gastritis with bile reflux, esophagitis, esophageal hernia. The doctor gave chlorpromazine to treat stubborn hiccups, the symptoms improved, and there was no violation of the norms of diagnosis and treatment.
The patient developed cerebral infarction within 1 month, and the doctor did not fully assess the patient's cognitive function and mental condition. On November 19, the patient was mentally weak, it is advisable to choose to measure the ear temperature, armpit temperature or rectal temperature, the nurse completes this work, but the doctor measures the oral temperature, and the non-nurse completes, which is the improper choice of body temperature measurement method, the operation is not standardized, resulting in the patient biting and swallowing the thermometer, and needs to be removed by gastroscope, causing transient damage, there is a fault.
According to the clinical manifestations and test results of the patient after discharge, there were no signs and evidence of mercury poisoning (acute corrosive stomatitis, irritability, intention tremor) and perforation of the upper gastrointestinal tract (abdominal pain, etc.).
Seven. Court judgment
The corresponding loss of the patient's medical treatment after biting and swallowing the thermometer shall be borne by the defendant. On February 3, 2020, the court ruled that the defendant x university affiliated x hospital x branch compensated the plaintiff for losses of RMB27,355.64.
【Statement】Judicial adjudication cases. #医疗纠纷 #